1 Morris JK, Cook DG. A critical review of the effect of factory closures on health. Br J Ind Med 1991;48:1-8. 2 Hallsten L. Mental health and unemployment. On health-based selection to work. Arbete och Hälsa 1998:7. (Dissertation in Swedish with English abstract.) 3 Weich S, Lewis G. Poverty, unemployment, and common mental disorders: population based cohort study. Bethune A. Economic activity and mortality of the 1981 census cohort in the OPCS longitudinal study. Popul Trends 1996;83:37-42. 8 Martikainen P, Valkonen T. Excess mortality of unemployed men and women during a period of rapidly increasing unemployment. Lancet 1996;348:909-12. 9 Bartley M. Unemployment and ill health: understanding the relationship. J Epidemiol Community Health 1994;48:333-7. 10 Avery AJ, Betts DS, Whittington A, Heron TB, Wilson SH, Reeves JP. The mental and physical health of miners following the 1992 national pit closure programme: a cross sectional survey using general health questionnaire GHQ-12 and short form SF-36. Public Health 1998;112:169-73. 11 Matikainen E, Liira J, Rytkönen H. Health, work ability and working conditions of construction workers. Study design and follow-up in 1991-1995. Työ ja ihminen 1998;12:85-93, 152. (In Finnish with English abstract.) 12 S-PLUS 4 guide to statistics. Seattle: Data Analysis Products, Math Soft, 1997. 13 Leino-Arjas P, Liira J, Mutanen P, Malmivaara A, Matikainen E. Unemployment, health and health behaviour of construction workers. Työ ja ihminen 1998;12:139-48, 155. (In Finnish with English abstract.) 14 Ryan J, Zwerling C, Jones M. Cigarette smoking at hire as a predictor of employment outcome. J Occup Environ Med 1996;38:928-33. 15 Lee AJ, Crombie IK, Smith WCS, Tunstall-Pedoe HD. Cigarette smoking and employment status. Soc Sci Med 1991;33:1309-12. 16 Dooley D, Catalano R. Unemployment as a stressor: findings and implications of a recent study. In: Badura B, Kickbusch I, eds. Health promotion research. Towards a new social epidemiology. Copenhagen: WHO Regional Publications, 1991:313-39. (European series No 37.) 17 Morris JK, Cook DG, Shaper AG. Non-employment and changes in smoking, drinking, and body weight. BMJ 1992;304:536-41. 18 Janlert U, Hammarström A. Alcohol consumption among unemployed youths: results from a prospective study. Br J Addict 1992;87:703-14. 19 Montgomery SM, Cook DG, Bartley MJ, Wadsworth M. Unemployment, cigarette smoking, alcohol consumption and body weight in young Brit-ish men. Eur J Publ Health 1998;8:21-7. 20 Liira J, Leino-Arjas P. Unemployment in construction and forest work. Predictors and consequences in a 5-year follow-up. Scand J Work Environ Health 1999;25:42-9. 21 Ezzy D. Unemployment and mental health: a critical review. Abstract Objectives To examine the adherence by senior NHS medical staff to the BMA guidelines on the ethical responsibilities of doctors towards themselves and their families. Design Postal semistructured questionnaire. Setting Four randomly selected NHS trusts and three local medical committees in South Thames region.
OBJECTIVES: This study analyzed the long-term association between religious attendance and mortality to determine whether the association is explained by improvements in health practices and social connections for frequent attenders. METHODS: The association between frequent attendance and mortality over 28 years for 5286 Alameda Country Study respondents was examined. Logistic regression models analyzed associations between attendance and subsequent improvements in health practices and social connections. RESULTS: Frequent attenders had lower mortality rates than infrequent attenders (relative hazard [RH] = 0.64;95% confidence interval [CI] = 0.53,0.77). Results were stronger for females. Health adjustments had little impact, but adjustments for social connections and health practices reduced the relationship (RH = 0.77; 95% CI = 0.64, 0.93). During follow-up, frequent attenders were more likely to stop smoking, increase exercising, increase social contacts, and stay married. CONCLUSIONS: Lower mortality rates for frequent religious attenders are partly explained by improved health practices, increased social contacts, and more stable marriages occurring in conjunction with attendance. The mechanisms by which these changes occur have broad intervention implications.
Studies of disability in old age have focused on gross measures of physical functioning. More useful results for prevention might be gleaned from examining risk factors associated with frailty, a concept implying a broader range of more subtle problems in multiple domains. This study conceptualized frailty as involving problems or difficulties in two or more functional domains (physical, nutritive, cognitive, and sensory) and analyzed prospective predictors. Subjects were 574 Alameda County Study respondents age 65-102. One-fourth scored as frail; there was no gender difference. Frail persons reported reduced activities, poorer mental health, and lower life satisfaction. Cumulative predictors over the previous three decades included heavy drinking, cigarette smoking, physical inactivity, depression, social isolation, fair or poor perceived health, prevalence of chronic symptoms, and prevalence of chronic conditions. By modifying these risk factors, it may be possible to postpone the onset of frailty or ameliorate its further development.
Several recent prospective analyses involving community-based populations have demonstrated a protective effect on survival for frequent attendance at religious services. How such involvement increases survival are unclear. To test the hypothesis that religious attendance might serve to improve and maintain good health behaviors, mental health, and social relationships, changes and consistencies in these variables were studied between 1965 and 1994 for 2,676 Alameda County Study participants, from 17 to 65 years of age in 1965, who survived to 1994. Measures included smoking, physical activity, alcohol consumption, medical checkups, depression, social interactions, and marital status. Those reporting weekly religious attendance in 1965 were more likely to both improve poor health behaviors and maintain good ones by 1994 than were those whose attendance was less or none. Weekly attendance was also associated with improving and maintaining good mental health, increased social relationships, and marital stability. Results were stronger for women in improving poor health behaviors and mental health, consistent with known gender differences in associations between religious attendance and survival. Further understanding the mechanisms involved could aid health promotion and intervention efforts.
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